ABSTRACT Impaired swallowing (oropharyngeal dysphagia or OPD) causes nearly 150,000 annual hospitalizations and over 220,000 additional hospital days, and prolongs hospital lengths of stay by 40%. OPD risk is typically identified through subjective standard institutional screening (SIS) protocols and those identified through screening undergo gold standard imaging testing such as videofluoroscopy (VF). However, SIS methods over- or underestimate risk, and completely fail to identify patients with silent OPD who silently aspirate food into their lungs, raising their risk of pneumonia and other adverse events. Pre-emptive detection of silent or near- silent aspiration is essential. Our long-term goal is to develop an instrumental dysphagia screening approach based on high-resolution cervical auscultation (HRCA) to accurately predict OPD-related adverse events, and initiate more timely intervention measures to mitigate them. The overall objective here is to develop accurate, advanced data analysis approaches to translate HRCA signals to swallowing events observed in VF images. Our strong preliminary data has led us to our central hypothesis: HRCA coupled with advanced data analytics tools are powerful approaches to automate and improve existing dysphagia screening protocols. The rationale is that a reliable, robust early-warning instrumental OPD screening approach will reduce adverse events in patients with silent aspiration/dysphagia, shorten length of stay, reduce cost, and improve patient health. Guided by strong preliminary data, we will pursue the following three specific aims: (1) define HRCA signal signatures that characterize the entire continuum swallowing safety from unimpaired to severely impaired; (2) translate HRCA swallow signal signatures and equate them to validated measures of swallowing impairment; and (3) prospectively assess the effectiveness of our HRCA system in predicting clinically significant OPD and aspiration in a randomized, controlled trial. Under the first aim, we will collect HRCA swallow signatures from unimpaired people, and combine and analyze them along with our large database of swallows of people with OPD to characterize the entire range of swallowing function from unimpaired through severe OPD. Under the second aim, we will develop HRCA OPD severity cutoffs and match them to gold standard derived OPD impairment cutoffs to establish HRCA?s ability as a diagnostic surrogate that differentiates clinically significant OPD and aspiration from benign swallowing impairments. Under the third aim, we will test HRCA in a clinical setting by deploying HRCA with consenting patients, and comparing the accuracy of independent HRCA, independent SIS, and HRCA+SIS to VF data from all participants. The approach is innovative, as it will combine technology with clinical judgment to shift the OPD screening paradigm and fundamentally improve efforts to reduce morbidity and mortality caused by OPD. Our work is significant, because it will translate to an early-warning HRCA screening tool that will elevate the current standard of patient care by ensuring that patients with OPD are correctly identified before adverse events can occur.